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Program Highlights

Cervical cancer is the number one cancer killer of women in sub-Saharan (SSA), with roughly WLHIV on Cervical Cancer Malawi Funding Amount 110,000 women diagnosed annually; of these women, Treatment* Screening Target about 66% will die from the disease. Women living FY19 $5,409,699 449,407 42,179 with HIV (WLHIV) are up to six times more likely to develop persistent precancerous lesions and progress to cervical cancer, often with more aggressive form FY20 $2,199,935 200,136 101,507 and higher mortality. FY21 $3,000,000 378,235 103,671 Launched in May 2018 to address this challenge, Go

Further is an innovative public-private partnership * For FY19, this is the number of women aged 30+ estimated to be on treatment; otherwise, between the U.S. President’s Emergency Plan for this is women aged 25-49 on treatment at the end of FYs 18 and 19, respectively. AIDS Relief (PEPFAR), the George W. Bush Institute, (Source: PEPFAR Panorama Spotlight) the Joint Programme on HIV/AIDS (UNAIDS), and Merck. The partnership collaborates closely with governments to strategize on ways to provide services for women from prevention through the cancer journey. Go Further began working in eight (, Eswatini, , Malawi, , , , and ), and will expand services to four additional countries (, , , ) in fiscal year (FY) 2021. The objectives are to screen all WLHIV on ART between the ages of 25 and 49 for cervical cancer, and to treat pre-invasive cervical cancer lesions to prevent progression to cervical cancer.

Country Context

Total Population Estimate (PEPFAR Malawi Strategic Di- 19,500,000 rection Summary 2020)

Women Aged 15-49 HIV Prevalence Rate 10.8% (UNAIDS 2020) Placeholder for Detailed Map Age-standardized Incidence Rate (per 100,000) of Cervical Cancer Cases (Estimates for 2020) 67.9 (https://gco.iarc.fr/)

Total # of Women (All Ages) On ART 533,669 (PEPFAR, FY20 Q4)  In FY20: 81,081 screenings were done, representing 80% of the FY20 target, and 73% of women who screened positive for precancerous lesions were treated.

 Since FY18: 1,507 women have screened positive for suspected invasive cervical cancer. Of the 118,639 screenings. 93,217 (78.6%) were first time screenings, 1,240 (1.0%) were follow-up screenings, and

24,182 (20.4%) were re-screens. RESULTS SUMMARY

Strategic Direction for FY21

 PEPFAR, in collaboration with the Ministry of Health and stakeholders, is introducing LEEP services to all district hospitals (secondary referral level) to improve access for WLHIV. PEPFAR implementing partners continue to strengthen referral networks for WLHIV in need of LEEP and specialized care for those presumed to have cervical cancer where these services are not available.

 In line with the Operational Plan guidance for FY21, implementing partners are supporting referral logistics including histopathology costs to enhance diagnostic work up and facilitate appropriate management for WLHIV in need. Implementing Partners (FY21)

 PEPFAR Malawi employs a hub and spoke model to expand services to  The Lighthouse Trust facilities surrounding the district hospitals and other large mission hospitals. This allows for minimal investments for high impact through  Elizabeth Glaser Pediatric AIDS Foundation outreach clinics in facilities that are otherwise smaller in their WLHIV volume. However, this initiative is affected by the ongoing second wave  Baylor College of Medicine Children’s Foun- of the COVID19 pandemic in Malawi. dation

 Partners In Hope

 Jhpiego

Go Further • www.gofurther.org • Malawi • Page 2 February 2021